Provider Demographics
NPI:1770855132
Name:LOS ANGELES CHRISTIAN HEALTH CENTERS
Entity Type:Organization
Organization Name:LOS ANGELES CHRISTIAN HEALTH CENTERS
Other - Org Name:PICO ALISO COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BETTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-893-1960
Mailing Address - Street 1:1625 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-4201
Mailing Address - Country:US
Mailing Address - Phone:323-268-8391
Mailing Address - Fax:858-633-4702
Practice Address - Street 1:1625 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4201
Practice Address - Country:US
Practice Address - Phone:323-268-8391
Practice Address - Fax:858-633-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
CAPHY499153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770855132Medicaid
2134659OtherPK